Malik AA, Bari SU, Rouf KA, Wani KA. Pyogenic liver abscess: Changing patterns in approach. World J Gastrointest Surg 2010; 2(12): 395-401 [PMID: 21206721 DOI: 10.4240/wjgs.v2.i12.395]
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Dr. Shams UL Bari, Professor, MBBS, MS, Consultant Surgeon, Department of Surgery, Sheri Kashmir Institute of Medical Sciences Medical College, R/o Professors Colony, Naseem Bagh, Hazratbal, Srinagar, Kashmir 190006, India. shamsulbari@rediffmail.com
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World J Gastrointest Surg. Dec 27, 2010; 2(12): 395-401 Published online Dec 27, 2010. doi: 10.4240/wjgs.v2.i12.395
Pyogenic liver abscess: Changing patterns in approach
Ajaz A Malik, Shams UL Bari, Khawaja Abdul Rouf, Khurshid Alam Wani
Ajaz A Malik, Khawaja Abdul Rouf, Khurshid Alam Wani, Department of Surgery, Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190006, India
Shams UL Bari, Department of Surgery, Sheri Kashmir Institute of Medical Sciences Medical College, Bemina, Srinagar, Kashmir 190006, India
Author contributions: Malik AA and Bari SUL performed most of the operations; Bari SUL designed the study and wrote the manuscript; Rouf KA and Wani KA helped in compiling the data.
Supported by The Department of Surgery and Medical Records Section Sheri Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India
Correspondence to: Dr. Shams UL Bari, Professor, MBBS, MS, Consultant Surgeon, Department of Surgery, Sheri Kashmir Institute of Medical Sciences Medical College, R/o Professors Colony, Naseem Bagh, Hazratbal, Srinagar, Kashmir 190006, India. shamsulbari@rediffmail.com
Telephone: +91-194-2429203 Fax: +91-194-2493316
Received: March 10, 2010 Revised: November 1, 2010 Accepted: November 8, 2010 Published online: December 27, 2010
Abstract
AIM: To define optimum management of the pyogenic liver abscess and assess new trends in treatment.
METHODS: One hundred and sixty nine patients with pyogenic liver abscess managed at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir (India) from July 2001 to August 2006 were studied to evaluate and define the optimum treatment.
RESULTS: Mortality in the surgically treated group of patients was 9.4% (12/119), while those treated non-surgically had a fatality rate of 16.66% (7/42). Multiple liver abscesses treated surgically had a surprisingly low mortality of 30%. The biliary tract (64.97%) was the most common cause of liver abscess. Multiple abscesses, mixed organisms and abscess complications are all associated with a significantly increased mortality. However, the lethality of the primary disease process was the most important factor in determining survival.
CONCLUSION: Transperitoneal surgical drainage and antibiotics are the mainstay of treatment. Percutaneous drainage is recommended for high risk patients only.
